Breech Presentation Flashcards
What is a breech presentation?
positioning of the fetus in a longitudinal lie with the buttocks or feet proximal to the cervix and the head near the fundus.
What are the types of breech presentations?
Frank, Footling, Complete
How is a breech presentation investigated?
Breech presentation can be detected through physical examination and confirmed with ultrasound imaging.
If the baby remains in breech presentation at term, options for delivery include external cephalic version (ECV), vaginal delivery, or caesarean section.
How is a breech presentation managed?
Management of breech presentation includes offering an ECV at 36 weeks for primiparous women, and at 37 weeks for multiparous women, provided there are no contraindications.
How is a breech presentation managed if ECV is unsuccessful?
If ECV is unsuccessful, the delivery may be performed vaginally or via caesarean section. Due to the increased risk of complications with breech vaginal deliveries, an elective caesarean section is often considered the safer option.
What is ECV?
manual procedure where an experienced physician attempts to turn the baby using their hands on the abdomen. usually carried out under ultrasound guidance. The mother is given analgesia, tocolytics and anti-D immunoglobulin (if required) during the procedure.
50% success rate
What are absolute contraindications for ECV?
Caesarean section is already indicated for other reason
Antepartum haemorrhage has occurred in the last 7 days
Non-reassuring cardiotocograph
Major uterine abnormality
Placental abruption or placenta praevia
Membranes have ruptured
Multiple pregnancy (but may be considered for delivery of the second twin)
What are relative contraindications for ECV?
Intrauterine growth restriction with abnormal umbilical artery Doppler index
Pre-eclampsia
Maternal obesity
Oligohydramnios
Major foetal abnormalities
Uterine scarring from previous caesarean section or myomectomy
